Digestion and Stomach Acid
Reflux and Heartburn – Is It Always Caused by Too Much Stomach Acid?
Acid reflux, heartburn, burping or discomfort after eating? To understand reflux, we first need to understand what stomach acid is actually meant to do – and why the solution is not always as simple as reducing it.
You know the feeling: a burning sensation rising from your chest towards your throat.
Perhaps after a large meal. Perhaps late in the evening. Perhaps almost every day. The most common reaction is to think “too much stomach acid” – and reach for an antacid tablet or an over-the-counter acid-reducing medication. Often, it helps, at least for a while.
But the question we rarely ask is: why did the acid end up where it should not be in the first place?
Stomach acid and the stomach are normal. The problem occurs when stomach contents come up where they should not be.
This article is not about frightening you away from acid-reducing medication, nor is it about convincing you that “everyone” has too little acid. It is about understanding the mechanism – so that you and your doctor can make an informed decision together.
Why the stomach needs acid
The stomach is normally highly acidic, with a pH of around 1.5–3.5. This low pH is not a system error – it is essential for digestion to function.
Stomach acid (hydrochloric acid, HCl) activates the enzyme pepsin from its inactive precursor, pepsinogen, and pepsin is what begins breaking down proteins in food. The acidic environment also helps release and make certain nutrients available, including iron, vitamin B12 and calcium, so they can be absorbed more easily further down the intestine. In addition, the low pH acts as a barrier against many of the bacteria and microorganisms that come with the food we eat.
In other words: a well-functioning stomach with sufficient acid is essential for good digestion – it is not something you want to remove or neutralize more than necessary.
Why stomach acid should not be in the esophagus
The stomach lining is specially adapted to withstand this acidic environment, in part through a protective layer of mucus and bicarbonate. The esophagus does not have the same protection. Its lining is designed to transport food downwards – not to withstand repeated contact with stomach acid.
Between the esophagus and the stomach is the lower esophageal sphincter (LES) – a ring of muscle that normally stays closed and opens only briefly when you swallow. This one-way valve function is what keeps the acid where it belongs.
When the LES weakens, opens too often or does not close properly, stomach contents – including acid – can flow back up into the esophagus. This causes the burning sensation we know as heartburn.
Why does reflux occur?
Reflux is rarely caused by the stomach suddenly producing an abnormally large amount of acid. Most often, it is caused by changes in the conditions around the LES and the stomach, so that acid that would normally stay in the stomach instead comes up where it should not be.
Factors that can contribute to reflux
Weakened LES function
The ring of muscle between the esophagus and stomach does not seal properly, or opens too often.
Hiatal hernia
Part of the stomach has shifted up through the diaphragm, which can affect LES function.
Increased abdominal pressure
Large meals, tight clothing, excess weight or pregnancy can increase pressure and push stomach contents upwards.
Delayed gastric emptying
Food stays in the stomach longer, giving it more time and opportunity to flow back up.
Position immediately after a meal
Lying down or bending forward shortly after a meal makes it easier for stomach contents to move upwards.
Certain foods, alcohol and smoking
In some people, these can affect LES pressure or directly irritate the esophageal lining.
Certain medications
Some medications can affect LES function or gastric emptying – talk to your doctor or pharmacist if you suspect a connection.
That is why “reduce the acid” is rarely the whole answer – the real question is often why the acid is ending up in the wrong place.
Too much or too little acid – why it is not that simple
Here is something that often comes as a surprise: symptoms such as heartburn, bloating, burping and discomfort after meals can occur in practice with both high and low acid levels. Symptoms alone do not reliably reveal which mechanism is behind them.
We do not recommend trying to increase or reduce stomach acid on your own based on symptoms alone. Both high and low acid levels can cause similar symptoms, and an incorrect assumption may delay appropriate care. If symptoms persist, a doctor should assess the cause and, if necessary, arrange relevant tests.
Acid-reducing medication (PPIs) – an honest overview
Proton pump inhibitors (PPIs) are among the most commonly used medications for reflux and heartburn, and for many people they are both appropriate and important. For conditions such as erosive esophagitis, Barrett’s esophagus, stomach ulcers or as part of treatment for an H. pylori infection, PPIs can be a central and well-documented part of treatment.
At the same time, clinical guidelines, including those from the American Gastroenterological Association (AGA), note that PPIs are often started for a limited period – typically 4–8 weeks for uncomplicated reflux – and that the need for continued use should be reassessed afterwards, rather than continuing automatically indefinitely.
There are groups for whom long-term use is well justified, for example people with severe erosive esophagitis, Barrett’s esophagus, or a high risk of bleeding while also taking blood thinners or anti-inflammatory medication. For others, it may be appropriate to discuss with their doctor whether the lowest effective dose is suitable, or whether a PPI is still needed.
Some research has linked long-term use to changes in the absorption of certain nutrients, including vitamin B12, magnesium and calcium. This does not mean that everyone who uses PPIs over time develops deficiencies, but it is a reason to periodically reassess treatment – not a reason to stop on your own.
This article does not encourage you to stop taking or change the dose of acid-reducing medication on your own. The use, tapering and potential discontinuation of PPIs should always be done in consultation with a doctor who knows your full medical history and can assess whether continued use, a dose adjustment or other tests are right for you. Betaine HCl in Digestive Support (see further down in the article) works through a completely different mechanism than PPIs, and the two are not intended to be combined. So if you want to try Digestive Support while taking a PPI, this is a decision you and your doctor should make together – not something to decide on your own.
How is the diagnosis made?
Since symptoms alone do not always provide a clear answer, your doctor can use several tools to understand what is actually happening.
Assessment
Common diagnostic methods for reflux
An overview of the tools your doctor may use – the appropriate method depends on your symptoms and medical history.
| Method | What it shows | When it is appropriate |
|---|---|---|
| Gastroscopy | Direct examination of the esophagus and stomach. Can detect inflammation, ulcers or Barrett’s esophagus. | For warning signs, long-lasting symptoms or lack of improvement with treatment. |
| H. pylori test | Whether the H. pylori bacterium is present (breath test, stool sample or biopsy). | If a stomach ulcer or chronic gastritis is suspected. |
| pH/impedance monitoring | Measures actual acid exposure and the number of reflux episodes over approximately 24 hours. | When the diagnosis is unclear or symptoms do not respond to treatment as expected. |
| Biopsy | A tissue sample taken during gastroscopy for closer microscopic examination. | If findings during gastroscopy need further investigation. |
The doctor chooses the examination based on an overall assessment of symptoms, age and medical history.
My own case
In my own clinical history, I have low acid levels (hypochlorhydria) and antibodies against parietal cells – the cells in the stomach that produce acid. This is a completely different mechanism from classic reflux linked to weakened LES function or high acid levels, but at times the symptoms can be similar: bloating, discomfort and burping after meals.
The same symptom does not mean the same mechanism. My story is not a definitive guide to interpreting your own symptoms – it illustrates how different the underlying causes can actually be.
That is exactly why, in our clinical practice, we do not start by making assumptions – we start by assessing the situation.
Practical steps you can take
Things you can do today
- Eat regular meals at roughly the same time each day. Your body gets used to a routine, which can make it easier for the digestive system to release enzymes and stomach acid at the right time.
- Avoid snacking between meals. Instead, stick to regular meals that leave you satisfied but are not excessively large, so the stomach does not have more to break down than it can digest properly.
- Avoid drinking large amounts of fluid right before, during or immediately after a meal – this can dilute stomach acid and make digestion more difficult.
- Feel free to drink water with electrolytes in the morning and between meals, at least one hour away from food. The stomach needs sufficient fluids and electrolytes to produce digestive juices.
- Avoid tight clothing and belts, and avoid bending forward immediately after meals – this increases abdominal pressure and can push stomach contents upwards.
- Do not be afraid of natural, unprocessed salt and herbs – they are natural allies for digestion. Instead, limit refined salt and highly processed foods.
- Look after your dental health. If you have old amalgam fillings, it may be worth reading more about why this is relevant to digestion.
- Do you suffer from chronic sinusitis or mucus dripping down the back of your throat (postnasal drip)? This can also affect digestion and is worth looking into.
- Review the medications you take, and talk to your doctor or pharmacist about how they may affect the pH level in your stomach. Some medications can affect digestion without you realizing it.
- Consider trying Digestive Support for general support of digestive function – you can read more about the formula further down in the article.
- Electrolytes also play a role in the stomach’s ability to release sufficient stomach acid, since hydrochloric acid production depends on sodium, chloride and potassium, among other things. Consider trying PureNordic Electrolytes to support this.
Digestive Support – support for the digestive system
As you have seen, reflux and heartburn can have many different underlying mechanisms – weakened LES function, low acid levels, delayed gastric emptying or several of these at once. That is why Digestive Support is designed to take a broad approach: instead of adjusting a single value, the formula is put together to support several of digestion’s natural steps at once and help the digestive system find its own natural balance. For many people, this broad, regulating approach may be worth trying.
The formula contains digestive enzymes that support the breakdown of protein, fat and carbohydrates, betaine HCl which may help create a sufficiently acidic environment in the stomach in people with low acid levels, ox bile to support fat digestion, herbal ingredients and Saccharomyces boulardii to support the normal function of the intestinal lining.
Digestive Support is not marketed as a treatment for reflux or heartburn, but as general support for digestive function. If you take acid-reducing medication (PPIs), or have active reflux, gastritis or a stomach ulcer under investigation, check with a doctor or other qualified healthcare professional before using Digestive Support – see the section on PPIs above for more information.
What people say after using Digestive Support
Here is what people report after using Digestive Support regularly over time. Individual results and needs vary.
“My digestion has improved significantly. I hardly get bloated anymore, and my stomach feels lighter after meals.”
— Mats, Oslo
“Works well for my IBS.”
— Runar, Kristiansand
“Worked really well for me; I’m on my second bottle. Recommended.”
— Ifrah, Oslo
“After 2 months of PureNordic supplements, my health has improved significantly. Thank you.”
— Sławomir, Poznań
The common themes are less bloating, greater regularity and the feeling that digestion is “working with you” better. Digestive Support is not intended as a solution for active reflux or heartburn.
Silicon – support for rebuilding the lining
When the lining is irritated over a long period – as with inflammation (esophagitis or gastritis) or superficial damage to the lining (erosions) – the body’s own ability to rebuild the lining is essential. Silicon is a mineral the body uses to produce collagen and connective tissue, which the linings of both the esophagus and stomach depend on to function as a protective barrier.
In liquid form, silicon is readily available for the body to absorb. If your lining is under extra strain – for example, during periods of irritation or after a doctor has found superficial damage to the lining – it may be worth learning more about Silicon as part of a comprehensive approach to digestive health.
Silicon is not a treatment for esophagitis, gastritis, stomach ulcers or other damage to the lining, and does not replace medical assessment or treatment of these conditions. If damage to the lining is active or persistent, discuss use with a doctor.
Red flags – when should you see a doctor?
Most cases of heartburn and reflux are harmless and can be managed in a routine medical setting. However, certain signs should always be checked by a doctor, regardless of how long you have had symptoms:
- Persistent difficulty swallowing or the feeling that food is getting stuck
- Unintentional weight loss
- Blood in vomit, or black/tarry stools
- Persistent vomiting
- Chest pain, especially with shortness of breath, sweating or pain radiating to the arm/jaw — seek emergency care immediately to rule out a heart-related cause
- Unexplained anemia or low iron
- New-onset reflux after age 50
- Symptoms that do not improve despite treatment
This list is not exhaustive and does not replace a medical assessment. If you have chest pain with shortness of breath, seek emergency care immediately.
Reflux – what should you do now?
You get occasional heartburn a few times a month
→ Start with simple lifestyle changes: meal size, timing and your position after meals.
You have frequent heartburn, several times a week
→ Talk to a doctor. Persistent reflux should be assessed and possibly investigated – not just treated for symptom relief.
You have been taking PPIs for a long time without a recent review
→ Ask your doctor to periodically review whether you still need them. Do not stop or change the dose on your own.
You have reflux along with other digestive symptoms, such as bloating or irregular bowel movements
→ It may be relevant to look at digestion as a whole, rather than focusing only on acid levels.
You have one or more red flags
→ See a doctor for further assessment as soon as possible.
The PureNordic principle: Find the function first
Reflux is a symptom. The next question is why stomach contents are ending up in the wrong place.
For one person, it is due to a weakened LES. For another, it is a hiatal hernia or increased abdominal pressure. For a third, like me, the symptoms can sometimes resemble reflux even though the mechanism is different. That is why we have two goals:
Relieve discomfort when necessary, in consultation with a doctor where appropriate.
Understand why stomach contents are ending up in the wrong place – especially when symptoms persist or return.
That is what we mean by Find the function first.
PureNordic mini protocol
To summarize the practical steps in the section “Things you can do today,” we have put together a simple mini protocol. This is an example of how the elements can be combined in practice – not a prescribed treatment plan. It should always be tailored to the individual, especially when taking acid-reducing medication or other medicines.
Start with the basics
Begin with the steps described earlier in the article under “Things you can do today” – meal timing, fluid intake and your position after meals.
Fluid intake in the morning
Drink PureNordic Electrolytes dissolved in water in the morning, at least one hour before your first meal. A sufficient balance of fluids and electrolytes is essential for the stomach to produce digestive juices.
Digestive Support with protein-rich meals
Take 1–2 capsules of Digestive Support with each protein-rich meal, preferably 3–5 minutes before you start eating. Swallow with a small amount of water – avoid drinking large amounts of fluid at the same time as the capsules.
B-complex (methylated)
May be particularly relevant for those who have had low iron stores or signs of B-vitamin deficiency over time. B vitamins are involved in nerve and muscle function in the gastrointestinal tract, including the myoelectric complex and the vagus nerve’s regulation of sphincter muscles. Read more about our B-Complex (methyl form/TMG).
Silicon morning and evening
Take 0.5 ml of Silicon morning and evening, especially during periods when the lining is irritated or under extra strain.
Broth morning and evening
Have warm broth twice daily – preferably on an empty stomach in the morning with the electrolytes, and again in the afternoon or evening. Broth contains collagen and amino acids, among other things, which are building blocks for the lining.
The protocol is intended as general inspiration, not as an individual treatment plan. If you take acid-reducing medication (PPIs), the combination with Digestive Support should be discussed with a doctor – see the section on PPIs above.
Have you had heartburn or reflux for a long time?
Have you already tried antacids or over-the-counter products without getting lasting relief?
Then the next step may be to look more closely at why.
During a consultation, we assess your diet, symptom patterns, medication use, lifestyle factors and whether further medical investigation may be appropriate.
The goal is not just to relieve the symptom. The goal is to understand why it occurs.
Book a consultation →Supplements are not a substitute for a varied diet, a healthy lifestyle or necessary medication. If you have reflux symptoms, take acid-reducing medication (such as PPIs), have a medical condition, are pregnant or take other medication, always check with a doctor or other qualified healthcare professional before using supplements or making any changes to your medication. Individual needs vary. This article is intended for general information and does not replace an individual medical assessment.
